Governor Nomination Safeguarding Self-Declaration Form (Confidential)

  • Why does the Diocese ask for this form to be completed? The Diocese wishes to provide you, as the applicant, with the opportunity to voluntarily disclose any convictions, cautions, warnings or bind-overs that are relevant to the role for which you are applying. This helps to avoid any possible subsequent delay in the appointment process. There is also an expectation that the Diocese seeks references on an applicant’s skills and suitability as part of the recruitment process. Who will have access to the completed document and its contents? The completed form and its contents will only be shared/reviewed by those with the entitlement to do so to assess relevancy of the contents e.g. the Bishop and appropriate members of the Clifton Diocese staff, the Chair of Governors of any school or Multi Academy Trust as appropriate, you may be considered for and/or appointed to, if necessary. What happens if something is declared? Any information you supply on the document will not necessarily bar you from being appointed as a governor. Should further information be warranted in light of your disclosure of information, your prior consent will be sought BEFORE further information or enquiries are made. A senior Bishop’s Officer contact will contact you to discuss any information you disclose and obtain any further details required to help assess the relevancy of the information in relation to the role of a school governor. How will decisions be made in light of information disclosed? Decisions will be made based on full examination of the information disclosed. You will be kept informed of the decision process and outcome. Who will be involved in the decision-making process? The Bishop and appropriate members of the Clifton Diocese staff and the Chair of Governors of any school you may be considered for, if necessary. Where will this document be held; by whom and for how long? This document will be retained by the Bishop’s Governance Officer. The document will be retained in accordance with the record retention schedule (or until a new Disclosure is required at which time a new Safeguarding Self-Declaration is necessary) and stored electronically on a password protected, secure file accessible only by authorised personnel e.g. Bishop’s senior representatives. If you have any queries regarding the completion of this document, please contact the Safeguarding office in confidence. If you have a disability that may make the completion of this document difficult, the document can be completed by someone on your behalf however we still require you to sign the document. If after reading the above, you wish to continue with your application, please complete the sections below:

Declaration (please read, sign and date)

  • * In the spirit of the Church’s commitment to protect and safeguard the vulnerable in our communities, I understand that to knowingly provide inaccurate information or omit information will be considered a breach of trust and may result in me being asked to step down from a governor post. * If I am subsequently convicted of any relevant criminal offence or become subject to investigation regarding safeguarding concerns or conduct issues, I will immediately declare this to the Director for Schools and Colleges. * I understand (in accordance with the General Data Protection Regulation 2016 and Data Protection Act 2018) that this document, and any enquiries made in response to the contents of this document, will be retained in accordance with the record retention schedule (or until such time that a new Disclosure is required including completion of a Self-Declaration), and in the event that I am not appointed will be destroyed. * By signing this Declaration, I provide consent to any school for which I am being considered checking the status of my Disclosure in the future should I subscribe to the online DBS Update Service. These checks will be carried out every 4 years and should this timeframe need to be adjusted for any reason, further consent will be sought. Should I step down from post I will notify the school and advise of my request to withdraw my consent. * I declare that the information I have given on this form is correct and true to my knowledge.
  • Information provided on this form, together with all other personal data held about these individuals by the Parish and the Clifton Diocese, is processed in accordance with the Diocese’s Privacy Notice; which is available at or from the Parish Office.